20030228.pdfDATE RECEIVED
.07
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
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ADDRESSF
100,
-15 04!:8v
TELEPHONE
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/1� - 3 1 1 PERMIT EXPIRES _LL'
USE PERMIT , ;4
ZONE NUMBER
:013 SUIT
ADDRESS
SZ'e,
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Pern* Required
Street Use Paffnft Wd
EXISTING - PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT
Underground
Wiring required CI
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESE3 NO 13 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
BY DATE
FIRE REVIEWED BY DATE I I'm",
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VARIANCE OR CU
SHORELINE OR ADBN INSPECTION BOND
STATE LICENSE NUMBER
EXPIRATION DATE I SHECKEErBY
REO'D I POSTED
I
'?/5,
E3 YES ONO C
&6aa1WA,Y
Vw&4
SEPA REVIEW
SIGN AREA. HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
UUMPLhit: EXEM13T ALLOWED PROPOSED ALLOWED PROPOSED
Al
Exp ,
,
E] RESIDENTIAL w1eum SING / MECH
LOT COVERAGE
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
NEW
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
2
COMPLIANCE OR
z
ADDITION
weo"MMERCIAL CHANGE OF USE
I
PARKING
LOT AREA PLANNING REVIEWED BY DATE
El REMODEL MULTIFAMILY SIGN
REOD PROVIDED
I
[3 GRADING FENCE
REPAIR CYDS ( X Fr)
REMARKS
DEMOLISH TANK OTHER
GARAGE
RETAININGWALL FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(PE OF USE, BUSINESS OR ACTIV" EXPLAIN:
CHECKED BY
CONSTR1,11cTiful OCCUPANT
-Ali
AMBER
GROUP
OF
N9MBER OF
DWELLING
CRITICAL
AREAS
SPECIAL INSPECTION
fAREA OCCUPANT
STORIES
UNITS
NUMBER
REQUIRED []YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
1212P221 .4
VALUATION
$
Description
FEE
Description
FEE
Plan Chec k
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
VESTED DATE
*Building Permit
Plumbing
City Surcharge
67—
PLAN CHECK NO:
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) VIILL REQUIRE
SFPARIATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
136 PERMIT LIMM I YEAR - PROVIDED WORK IS STAffrED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY: DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Receipt #
Recording Fee
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOJI..QODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building 011icial or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
WORn�q�COMPENSA?""CE AND RCW 18.27.
0 AWN ALE,, DATE
RE (OWN 0
DA7/1
IA05
A/DATE
771-022 0
:n T
RELEASED BY
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTiFl-
ORIGINALQE4 - YELLOV/INS6ECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
I
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .., ...................
FOUNDATION:
Footing ......................
Wall..........................
Z.
Pier/Porch .................
C)
Retaining Wall: ...........
Slab Insulation ..........
PLUMBING:
M,
Underground.............
M
0
Rough -In I ...................
Cbmmercial'Flnal ......
M
HEATING:
GasTest
C
....................
Cal
"Gas Piping .................
0
-n
Equipment .................
commercial Final .....
EXTERIOR SHEATHING
rh
C
:.NAILING ..........................
Al
C);
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ....................
Floor Insulation .........
Wall Insulation ...........
Z'L
Ceiling Insulation .......
SHEETROCK NAILING ...
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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I
DATE RECE2�',
PERMIT EXPIRES
e
J/
USE PERMIT
ZONE
CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
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SUITE/of
OWNER NAMEfNAME OF BUSINESS
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PLAT NAME/SUBD[VISION NO. LOT NO.
LID NO.
15 MAILING ADDRESS
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESGP AP
RW Perrros!
street use Perm aq
CITY ZIP TELEPHONE
EXISTING — PROPOSED
hupecition Requkad
Sidewalk Required
a.E.-
REQUIRED DEDICATION— FT
Underground
Widnilrequired 13
NAME
METER SIZE LINE Slii7NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
ADDRESS'
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
CITY ZIP TELEPHONE
NAME
CBLff,
CZ-411,1hial ",o,-se,1,--
,"/- ",2
1 Id
ENGINEERING REVIEWED BY
DATE
Alz�-?r
—2=,t7-Z6e
FIRE REVIEWED BY
DATE
CiTY
ZIP TELEPHONE
IZ
If
VARIANCE OR Cu
SHORELINE OR ADBN INSPECTION BOND
STATE LICENSE NUMBER
EXPIRATION DATE I CHEcKEffBY
REO'D POSTED
10YES
�kz-,4h
'71-5
ONO $
a.:�zz�
V-&a
SEPA REVIEW
SIGN AREA HEIGHT
3ROPERTY TAX ACCOUNT PARCEL NO.
UUMPLElt: EXEMPT ALLOWED PROPOSED ALLOWED PROP08ED
lgrjzO
9ZZk&
,
I I
4212
EXP
NEW
RESIDENTIAL
P4U10MBlNG/MECH
LOT COVERAGE
---
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
SIDE REAR FRONT LIRSIDE REAR
ALLOWED PROPOSED FRONT
COMPLIANCE OR
ADDITION
G40M MERCiAL
13 CHANGE OF USE
I
PARKING
LOT AREA PLANNING REVIEWED BY DATE
0 REMODEL 0 MULTIFAMILY
siGN
RE(YD I PROVIDED
0 REPAIR
0 GRADING FENCE
CYD-S C X Fr)
REMARKS
DEMOLISH
TANK
OTHER
oGARAGE
[3 RETAININGWALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(PE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
corm OCCUPANT
ITYP;EOFONSTRUCTI
GROUP
TUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
SPECIAL INSPECT1077
OCCUPANT
STORIES
UNITS
NUMBER
REQUIRED [3 YES
LOAD
DESCR18E WORK TO BE DONE
REMARK
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
VALUATION
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
VESTED DATE
Building Permit
Plumbing
City'Surcharge
PLAN CHECK NO:
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLZ ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
L, CEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: ISO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEKALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk.,9-%Kn1
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANN AND
Fire Inspection
.Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CffTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Receipt # 121-71;1
Recording Fee
1
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT' AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC-
CALL
This application Is not a permit unfli signed by the
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABORXODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or hisftf DepLdy: and Fees are paid, and
receipt Is acknovAedged In space provided.
WORn!E�COMPENSA79f-Ift-"CE AND RCW 15.27.
DATE
0:7
81
-$rTURE (OWN 0
(425)
�NAE,
1k
771-0 220
RELEASED BY 7 DATE-
ATTENTION
Off 1333
q1j
IT IS UNLAWFUL.,Tp USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
1 � 14
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINALkX34t YELLW. IN4ECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK-OWNEn GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
01113
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